Payment Integrity Analyst (Data Mining, Healthcare)

TL;DR

Payment Integrity Analyst (Data Mining): Investigate payment errors in healthcare claims due to incorrect processing of policies, contracts, billing, and coding to prevent and recover improper payments. Focus on validating payment terms, analyzing claims data, documenting audit-ready determinations, and recommending process improvements to enhance accuracy and reduce waste.

Location: Remote in the US; must be legally authorized to work in the U.S. (no visa sponsorship or immigration support)

Salary: $24.20 - $36.30 hourly (US base for full-time position)

Company

AI-first healthcare technology platform preventing inaccurate payments and reducing waste in the healthcare ecosystem.

What you will do

• Review, prioritize, and investigate assigned data mining leads, including complex and high-dollar cases, to verify payment errors.
• Validate payment terms using internal systems, payer portals, contracts, and coding guidelines (CMS, AMA).
• Document cases with clear rationale, evidence, and outcomes for audits, recovery, and reprocessing.
• Analyze trends, root causes of errors, and false positives to recommend workflow and data quality improvements.
• Collaborate with teams to configure business rules and prepare documentation for client reviews.
• Meet productivity, turnaround, and quality standards in a high-volume environment.

Requirements

• Must be legally authorized to work in the U.S. (no visa sponsorship)
• 1+ year combined experience in healthcare (health insurance, claims processing, adjudication, or fraud/waste/abuse detection).
• 1+ year auditing medical claims for improper payments as a Payment Integrity Vendor or in a Health Plan’s team.
• 1+ year performing data analytics on large datasets.
• 1+ year with medical billing codes (CPT, ICD-10-PCS/CM, HCPCS, NDC), medical terminology, and payment systems (DRG, OPPS, MIPS).

Nice to have

• Bachelor's degree in business or healthcare-related field.
• Experience with claim payment methodologies or payment integrity auditing.
• SQL experience.
• High-volume, SLA-driven operations experience.

Culture & Benefits

• Work in a recognized leader (2025 Best in KLAS for Pre-Payment Accuracy, HI-TRUST and SOC2 certified).
• Collaborative environment focused on innovation and operational excellence.
• Emphasis on attention to detail, problem-solving, and compliance (HIPAA, data security).